痙縮に対するバクロフェン持続髄注療法

Intrathecal Baclofen Therapy and Management of Severe Spasticity

バクロフェンは中枢神経系の抑制性伝達物質であるGABAの誘導体で，脊髄の単シナプスおよび多シナプス反射を抑制することで抗痙縮作用と鎮痛作用を示す。バクロフェン持続髄注の有益性として，①有痛性筋攣縮の軽減，②関節可動域の拡大と他動性の改善，③リハビリテーションへの導入，④夜間の攣縮低減による睡眠の改善，⑤更衣や排尿介助を容易にし，患者ケアの改善，⑥痙性膀胱など膀胱機能の改善，などが挙げられている。

Abstract

Continuous infusion of intrathecal baclofen (ITB), via implanted pump, is a powerful tool in the management of severe spasticity in neurological disorders. The advantages of ITB therapy are that it is non-destructive, reversible, and programmable, allowing for neuromodulation. Patients reported significant subjective improvements and decreases in muscle tone after baclofen injection, but excessive doses of ITB resulted in motor weakness. Few complications and adverse effects were reported. ITB therapy appears to be a promising treatment to improve residual motor control in patients with severe spasticity.